Physical Fitness Training for Patients With Stroke

Integrating Cardiac Rehabilitation in Stroke Recovery

Stroke remains a top contributor to long-term disability in the United States and substantially limits a person's physical activity. Decreased cardiovascular capacity is a major contributing factor to activity limitations and is a significant health concern. Addressing the cardiovascular capacity of stroke survivors as part of poststroke management results in significant improvements in their endurance, functional recovery, and medical outcomes such as all-cause rehospitalization and mortality. Incorporation of a structured approach similar to the cardiac rehabilitation program, including aerobic exercise and risk factor education, can lead to improved cardiovascular function, health benefits, and quality of life in stroke survivors.

Co-Designed Cardiac Rehabilitation for the Secondary Prevention of Stroke (CARESS): A Pilot Program Evaluation

Structured health system-based programs, such as cardiac rehabilitation, may reduce the risk of recurrent stroke. This study aimed to co-design and evaluate a structured program of rehabilitation, developed based on insights from focus groups involving stroke survivors and health professionals. Conducted in Tasmania, Australia in 2019, the 7-week program comprised one hour of group exercise and one hour of education each week. Functional capacity (6 min walk test), fatigue, symptoms of depression (Patient Health Questionnaire), and lifestyle were assessed pre- and post-program, with a historical control group for comparison. Propensity score matching determined the average treatment effect (ATE) of the program. Key themes from the co-design focus groups included the need for coordinated care, improved psychosocial management, and including carers and peers in programs. Of the 23 people approached, 10 participants (70% men, mean age 67.4 ± 8.6 years) completed the program without adverse events. ATE analysis revealed improvements in functional capacity (139 m, 95% CI 44, 234) and fatigue (-5 units, 95% CI -9, -1), with a small improvement in symptoms of depression (-0.8 units, 95% CI -1.8, 0.2) compared to controls. The co-designed program demonstrated feasibility, acceptability, and positive outcomes, suggesting its potential to support stroke survivors.

Effects of balance training in addition to auxiliary activity on balance function of patients with stroke at high risk for falls

Objective

The aim of this study was to investigate the effect of balance training in addition to auxiliary activity on the balance function of patients with stroke at high risk for falls.

Methods

A total of 112 patients with stroke at high risk for falls in our hospital from inception to January 2020 to December 2020 were selected as the research objects who were equally divided into the control group and study group according to the random number table method. Patients in the control group were intervened with auxiliary activity, and the patients in the study group received additional balance training for auxiliary activity. The balance function, lower extremity motor function, fall risk, walking ability, and other indicators were compared between the two groups of patients before and after treatment. The hospitalization time and the frequency of falls 3 months after discharge were also compared between the two groups.

Results

Before treatment, there was no significant difference in balance function, lower extremity motor function, fall risk, and walking ability scores between the two groups (P > 0.05). After 3 months of treatment, the balance function, lower extremity motor function, and walking ability scores of the study group were significantly higher than those of the control group, with the fall risk score significantly lower than that of the control group (P < 0.05). Evidently, lower hospitalization time and the frequency of falls in the 3-month follow-up of the study group were observed than those in the control group (P < 0.05). However, there was no significant difference in the frequency of falls between the two groups during hospitalization (P > 0.05).

Conclusion

Our results indeed revealed that balance training in addition to auxiliary activity elicited beneficial outcomes in terms of effectively improving the balance function and walking ability of patients with stroke at high risk of falling, which may have the potential for wide clinical application.

Rehabilitation of Cognitive Deficits Poststroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Despite the prevalence of cognitive impairment poststroke, there is uncertainty regarding interventions to improve cognitive function poststroke. This systematic review and meta-analysis evaluate the effectiveness of rehabilitation interventions across multiple domains of cognitive function.

METHODS

Five databases were searched from inception to August 2019. Eligible studies included randomized controlled trials of rehabilitation interventions for people with stroke when compared with other active interventions or standard care where cognitive function was an outcome.

RESULTS

Sixty-four randomized controlled trials (n=4005 participants) were included. Multiple component interventions improved general cognitive functioning (MD, 1.56 [95% CI, 0.69-2.43]) and memory (standardized MD, 0.49 [95% CI, 0.27-0.72]) compared with standard care. Physical activity interventions improved neglect (MD, 13.99 [95% CI, 12.67-15.32]) and balance (MD, 2.97 [95% CI, 0.71-5.23]) compared with active controls. Noninvasive brain stimulation impacted neglect (MD, 20.79 [95% CI, 14.53-27.04) and functional status (MD, 14.02 [95% CI, 8.41-19.62]) compared with active controls. Neither cognitive rehabilitation (MD, 0.37 [95% CI, -0.94 to 1.69]) nor occupational-based interventions (MD, 0.45 [95% CI, -1.33 to 2.23]) had a significant effect on cognitive function compared with standard care.

CONCLUSIONS

There is some evidence to support multiple component interventions, physical activity interventions, and noninvasive brain stimulation improving cognitive function poststroke. Findings must be interpreted with caution given the overall moderate to high risk of bias, heterogeneity of interventions, and outcome measures across studies.